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General NPI Number Information
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NPI Number | 1467284216
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Entity Type | Organization
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Legal Business Name | LASER SURGERY HOLDING COMPANY, LTD
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 20199 N 67TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85308-7001
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Country | US
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Telephone | 480-444-7491
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Fax | 480-908-4079
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Provider Business Mailing Address
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Address Line | 2228 W NORTHERN AVE STE B210
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City | PHOENIX
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State | AZ
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Zip | 85021-9336
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Country | US
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Telephone | 480-444-7491
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Fax | 480-908-4079
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | VELINA RUELAS
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Credential |
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Telephone | 602-908-0956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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